Provider Demographics
NPI:1730530874
Name:PLUNKETT, DUSTIN ROBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:ROBERT
Last Name:PLUNKETT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 VARNUM ST NE STE 6
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2110
Mailing Address - Country:US
Mailing Address - Phone:202-269-7103
Mailing Address - Fax:
Practice Address - Street 1:154 GARDNERS CIR
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-5467
Practice Address - Country:US
Practice Address - Phone:843-768-8376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1001737122300000X, 1223G0001X
VA04014153021223G0001X
SC9497122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice